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~~ <br />Gz/ <br />~ ANNI7AT. FFF] and REPORT RRnIJFST ~j ty <br />PERMITTEE NAME: `~ Rock-N-Pine LLC "~C~'~~LJ <br />PERMIT NO.: / M-2003-074 ~ "'MAR ~ ~ 2006 <br />OPERATION NAME: Rock-N-Pine ~rois~on of Minerals and eeefayy <br />ANNNERSARY DATE: February 5, 2006 <br />ANNUAL FEE DUE: $281.00 (Due ou or before your anniversary date) <br />COUNTY: Park <br />i~~ <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach xpnr revised written annual re~nrf and annnal repnrf maT to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Mark Balderson <br />Permittee Name: Rock-N-Pine LLC <br />Address: P.O. Box 1793 <br />Breckenridge, CO 80424 <br />Phone Number: (719) 836-9863 <br />Fax Number: (719) 836-9863 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />(_~l/~ <br />~~6 ~ <br />Signature of Corporat~e /Officer, Owner, or Designee <br />Z'~'~~(/ <br />Date <br />